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Presenting …

Nutrition and Osteoporosis

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Alice Henneman, MS, RD Linda Boeckner, PhD, RD
University of Nebraska–Lincoln Extension
Updated slightly, June 29, 2006
Extension is a division of the Institute of Agriculture and Natural Resources at the University of Nebraska-Lincoln cooperating with the counties and the U.S. Department of Agriculture.

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Disclaimer
The following information on nutritional aspects of osteoporosis is provided as information for general healthy eating. It should not be considered a substitute for seeking dietary advice from your own healthcare provider. Calcium and Vitamin D recommendations are based on those developed for the United States and Canada. They may not be appropriate for all countries due to differing dietary patterns and environmental factors.
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Typical comments from people with osteoporosis
“I’ve lost six inches in height and none of my clothes fit me anymore. Plus, it’s hard to get clothes that look nice when my back is so hunched over.”

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Comments

“What will I do if I have to give up driving?” 5

Comments
“Medications are expensive. But I can’t afford to let my condition get worse and this medicine will help stop or slow down the bone loss.”
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Comments “If somebody had told me sooner what I know now about osteoporosis, none of this might be happening to me!”
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Overview
Osteoporosis causes weak bones. In this common disease, bones lose minerals like calcium. They become fragile and break easily.

Normal Bone

Bone with Osteoporosis

Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

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Osteoporosis can strike at any age!
It is a myth that osteoporosis is only a problem for older women.

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The problem in America
• Major health threat for an estimated 44 million (55%) of people 50 years and older • 10 million estimated to have osteoporosis • 34 million have low bone mass placing them at risk • 1 in 2 women and 1 in 4 men over 50 will have an osteoporosis-related fracture
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Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

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1 in 5 people with a hip fracture end up in a nursing home within a year.

Some people never walk again.
Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

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Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

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The “silent disease”
• Often called the “silent disease” • Bone loss occurs without symptoms – First sign may be a fracture due to weakened bones – A sudden strain or bump can break a bone
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The most common breaks in weak bones are in the wrist, spine and hip.

Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

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Bones are living organs
• Calcium is deposited and withdrawn from bones daily. • Bones build to about age 30. • We need to build up a healthy bone account while young and continue to make deposits with age.

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• After mid-30’s, you begin to slowly lose bone mass. Women lose bone mass faster after menopause, but it happens to men too. • Bones can weaken early in life without a healthy diet and the right kinds of physical activity.

Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

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You’re never too young or old to improve bone health!
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Risk factors
If you have any of these “red flags,” you could be at high risk for weak bones. Talk to your health care professional.

Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

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 I’m older than 65  I’ve broken a bone after age 50

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 My close relative has osteoporosis or .has broken a bone  My health is “fair” or “poor”  I smoke  I am underweight for my height
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 I started menopause before age 45  I've never gotten enough calcium  I have more than two drinks of alcohol .several times a week  I have poor vision, even with glasses  I sometimes fall  I'm not active
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Source: “Calcium! Do You Get It?, ” FDA/CFSAN at http://www.cfsan.fda.gov/~dms/ca-toc.html 37

Using Nutrition Facts “serving size”
• Serving size on “Nutrition Facts” panel based on what people typically eat—it’s not a recommended amount. • Adjust calcium % DV if you eat a different serving size than on label.

Calcium requirements vary by age
If this is your age 0 to 6 months 7 to 12 months 1 to 3 years 4 to 8 years 9 to 18 years 19 to 50 years Over 50 years Then you need this much calcium each day (mg) 210 270 500 800 Growth 1,300 spurt 1,000 1,200
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Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You at http://www.surgeongeneral.gov/library/bonehealth

You need more vitamin D as you age
600 IU
600 500 400 300 200 100 0 up to 50 51-70 over 70
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Daily vitamin D needs in International Units (IU)

400 IU 200 IU

Age

It’s important to remember …
Some age groups need MORE or LESS than 100% DV for calcium and vitamin D. • Calcium requirements vary by age:
• More is needed as we grow older • Need is highest during rapid growth of adolescence.

Food is the best calcium source
• There may be additional substances in foods that affect the body’s absorption and use of their calcium. • A balanced diet that promotes a healthy weight may provide additional benefits to protect against osteoporosis.
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Calcium amount at one time
• Body can best handle about 500 mg calcium at one time from food and/or supplements. • Consume calcium sources throughout day instead of all at one time.
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Fiber
Excessive fiber—such as from overusing fiber supplements—could interfere with calcium absorption. Fiber naturally present in food should not be a problem and is beneficial to health.

Oxalic acid
Present in foods such as spinach, chard, beet greens and chocolate:
• Binds calcium in those foods • Doesn’t seem to affect calcium in other foods, including chocolate milk • These greens still good for you; may help calcium absorption in other ways

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High protein
Unbalanced, excessively high protein diets could increase urinary excretion of calcium.

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Soymilk
• Not all soymilk is calciumfortified or contains vitamin D; check “Nutrition Facts” panel. • 4 (8-oz.) glasses of soy milk may equal 3 (8-oz.) glasses of cow’s milk in availability of calcium. • Part of added calcium may be left in container when drinking some soymilks.
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Soy Milk

Soy Milk

Help for the lactose-intolerant
Some people lack the enzyme lactase needed to digest lactose (milk sugar). Here are some tips which may help people obtain calcium from dairy products…

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Start with small portions of foods such as milk and gradually increase serving size.
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Eat dairy foods in combination with a meal or solid foods.

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Try dairy foods other than milk: • Many hard cheeses (cheddar, Swiss, Parmesan) have less lactose than milk • Yogurt made with live, active bacteria
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It may be easier to digest lactose that is pre-digested or broken down to its simple sugar components (glucose and galactose): • Lactose-hydrolyzed milk and dairy products • Commercial lactase preparations

Calcium carbonate vs. citrate
Calcium carbonate
• Needs acid to dissolve and for absorption • Less stomach acid as we age • Often taken at meals when more stomach acid

Calcium citrate
• Doesn’t require stomach acid for absorption • May be taken anytime—check with your healthcare provider • May cost more
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Vitamin D necessary for calcium absorption
• Choose a supplement with vitamin D unless obtaining vitamin D from other sources. • Follow age group recommendation. Avoid going over a daily combined total of 2,000 IU or 50 mcg from food and supplements. • It’s not necessary to consume calcium and vitamin D at the same time to get the benefit of enhanced calcium absorption.
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Vitamin D is like a key that unlocks the door and lets calcium into the body.

Limit calcium to 500 mg at a time

500 mg

Our bodies can best handle about 500 mg calcium at one time from food and/or supplements. Spread your calcium sources throughout the day.
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Increase amount slowly
• Start supplements with 500 mg calcium daily for about a week, gradually adding more. • Gas and constipation can be side effects:
– Increase fluids and high fiber foods if diet is low in whole grains and fruits and vegetables. – Try a different type of supplement if side effects 81 continue.

Check for interactions

Check with physician or pharmacist for interactions with other prescriptions and over-the-counter drugs.

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Food is still important
• High calcium foods contain other KEY nutrients which are important in the diet. • Try to obtain some (or all) of your calcium from your diet, not just supplements.
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Also, follow the other four prevention steps …
• Engage in regular weight-bearing exercise. • Avoid smoking and excessive alcohol. • Talk to your doctor about bone health. • Have a bone density test and take medication when appropriate.

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Live well, live strong, live long
Osteoporosis is preventable for most people

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For more information

• The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means to You http://www.surgeongeneral.gov/library/bonehealth • National Osteoporosis Foundation http://www.nof.org This PowerPoint is available on the Internet at http://lancaster.unl.edu/food/osteoporosis.htm